1. Hypercalcemia Group Members: Joshua Griffith Jennifer Haynes

2. What is Hypercalcemia?  Hypercalcemia is too much calcium in the blood  > 10mg/dl of Ca+ in the blood. Calcium is important to many body functions, including: Bone formation Hormone release Muscle contraction Nerve and brain function

3. Physiology  Parathyroid hormone (PTH) and Vitamin D help manage calcium balance in the body.  PTH is made by the parathyroid glands, which are four small glands located in the neck behind the thyroid gland.  Vitamin D is obtained when the skin is exposed to sunlight, and from dietary sources such as:egg yolks, fish

5. Etiology of Hypercalcemia  Primary hyperparathyroidism is the most common cause of hypercalcemia.  It is due to excess PTH release by the parathyroid glands.  This excess occurs due to an enlargement of one or more of the parathyroid glands, or a growth on one of the glands. (Most of the time, these growths are not cancerous).

6. Etiology cont'd  Other conditions can also cause hypercalcemia:  An inherited condition that affects the body's ability to regulate calcium (familial hypocalciuric hypercalcemia)  Being bed-bound (or not being able to move) for a long period of time (this occurs most often in young people)

7. Etiology cont'd  Calcium excess in the diet. This is called milk-alkali syndrome. It is most often due to at least 2,000 milligrams of calcium per day. Taking too much vitamin D may add to the problem.  Hyperthyroidism  Kidney failure  Medications such as lithium and thiazide diuretics (water pills)

8. Etiology cont'd  Some cancerous tumors (for example, lung cancers, breast cancer)  Some infectious and inflammatory diseases such as tuberculosis, Paget's disease and sarcoidosis

9. Risk Factors of hypercalcemia  Women over age 50 (after menopause) are most likely to have hypercalcemia. In most cases, this is due to primary hyperparathyroidism. Hypercalcemia affects fewer than 1 in 100 people. Prevalence of hypercalcemia

10. Clinical Manifestation of Hypercalcemia  Abdominal symptoms:  Constipation  Nausea  Pain  Poor appetite/ loss of apetite  Vomiting  Weight loss- Anarexia  Increaased thirst

11. Cont'd of Clinical Manifestation  Kidney symptoms:  Flank pain  Frequent thirst  Frequent urination- full of excreted calcium- renal caclil (Kidney stones)  Confuesed to bizzare behavior-  Heart Contractilitly deacresaed- heart block and cardiac arrest  Muscles are weak- at great risk of falls

12. Cont'd CM  Muscle symptoms:  Muscle twitches  Weakness  Psychological symptoms:  Apathy  Dementia  Depression  Irritability

13. Cont'd CM  Memory loss  Skeletal symptoms:  Bone pain  Bowing of the shoulders  Fractures due to disease (pathological fractures)  Loss of height  Spinal column curvature

14. Treatment Actions  Restrict Ca+ intake  Loup Diuretics(Lasix)- excretion of calcium  Maintain Safe Environment  Weight bearing exercises

15. Treatment  Treatment is aimed at the cause of hypercalcemia whenever possible.  Primary hypercalcemia - surgery  Mild - monitor over time  Severe hypercalcemia that causes symptoms: Calcitonin  Dialysis  Diuretic medication, such as furosemide

16. Cont'd treatment  Drugs that stop bone breakdown and absorption by the body, such as pamidronate or etidronate (bisphosphonates)  Fluids through a vein (intravenous fluids) - this is the most important therapy  Glucocorticoids (steroids)

17. Complications of hypercalcemia  Osteoporosis  Kidney stones  Kidney failure  Nervous system problems  Abnormal heart rhythm (arrhythmia)

18. References  Bringhurst R, Demay MB, Kronenberg HM. Hormones and disorders of mineral metabolism. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds.Williams Textbook of Endocrinology 22/9/2015  Wysolmerski JJ, Insogna KL. The parathyroid glands, hypercalcemia, and hypocalcemia. In: Goldman L, Schafer AI, eds.Cecil Medicine 22/9/2015  https://www.youtube.com/watch?v=LIdAVjWwI Fo https://www.youtube.com/watch?v=LIdAVjWwI Fo 22/9/2015